James F. Arens, M.D., Chair
Committee on Standards and Practice Parameters

ctivities in the practice parameter arena remain very strong and ongoing, mainly because of the continuing interests of ASA members and the hard, dedicated work of the task forces.

At the 2005 ASA House of Delegates, four parameters were approved:

• “Practice Advisory for Intraoperative Awareness and Brain-Function Monitoring”;

• “Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery”;

• “Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea”; and

• An update of the “Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies.”

For 2006 the “Practice Guidelines for Obstetrical Anesthesia” will be updated. ASA will team with the Society of Cardiovascular Anesthesiologists (SCA) to update the “Practice Guidelines for Perioperative Transesophageal Echocardiography,” and a new practice parameter on preventing operating room fires will be developed. An update of the “Practice Guidelines for Chronic Pain Management” also will be started.

In the near future, the “Practice Guidelines for Preoperative Fasting” and “Practice Guidelines for Cancer Pain Management” will be updated. New parameters on central venous insertion and neuraxial anesthesia will be developed.

The committee is being asked to consider a parameter on the issue of medication management (avoiding medication errors) to thwart the efforts of national organizations from imposing unworkable regulations in the operating room environment.

One of the issues the committee faces is trying to balance the number of requests for new or updated parameters with the work capacity of the two committee methodologists. The committee also is aware of the need for ASA and its committees to be fiscally responsible.

In order for a parameter to be published by the National Guideline Clearinghouse <www.guideline.gov>, the parameter needs to be updated every five years. Some parameters have been allowed to be updated at a longer interval intentionally. If a parameter is to be updated at a five-year interval, the update process would have to start only three years after it was developed. For many parameters, little new information has come forth in that short interval. Thus the updating process would produce little new information and would be fiscally irresponsible. On the other hand, SCA requested this year that the House of Delegates approve an update on transesophageal echocardiography because of new information, and such approval was given.

The committee wishes to thank Michael E. Todd, M.D., editor of Anesthesiology, and the editorial board for their cooperation in publishing these parameters. We also commend the dedicated efforts of each and every task force, and we thank you, the ASA members, for your continued interest and support.

James F. Arens, M.D., is Professor and Chair, Department of Anesthesiology, University of Texas Medical School at Houston. He was ASA President in 1989.